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November 26, 2018

How Geisinger cut hepatitis C treatment costs by 20%—without sacrificing cure rate

Daily Briefing

    The medical community celebrated when researchers developed a breakthrough therapy that could fully eliminate hepatitis C, but the treatment's $100,000 price tag prompted Geisinger Health Plan to craft a unique approach to reducing costs. 

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    Geisinger's new treatment plan

    Geisinger partnered with pharmacists, nurses, and physicians to develop a standardized treatment regimen that would increase quality of care, reduce treatment time, and cut care costs.

    For example, the team worked together to determine which lab tests are needed, how often the patient should follow up with a physician, and which drugs are best for certain patients, Shelby Livingston reports for Modern Healthcare.

    Under Geisinger's treatment process, hepatitis C patients' ongoing care is managed by a multidisciplinary team over the phone or through an online portal, rather than in person with a hepatologist. According to Livingston, that change reduces the number of times the patient has to follow-up with a specialist.

    Geisinger was also able to reduce the course of treatment from 12 weeks to eight for some patients. The shorter treatment time saved "tens of thousands of dollars" for the health system while maintaining a 97.5% cure rate for patients, Livingston reports. 

    Shorter treatment can save time and money, without sacrificing quality

    A recent study confirmed that a shorter treatment regimen for hepatitis C can boast the same cure rate as the 12-week process—and save up to 20% of the drug's costs.

    For the study, which was presented this week at the annual meeting of the American Association for the Study of Liver Diseases, researchers followed 22 participants with hepatitis C in a control group to predict how long each patient would have to adhere to treatment before they are cured.

    Researchers measured how much the virus levels decreased in each patient after a few weeks of treatment and used mathematical modeling to determine how many weeks each patient would have to stay in treatment before the virus was completely eliminated.

    The researchers determined that one specific patient's treatment regimen could be reduced to 10 weeks, eight other patients could reduce their treatment to eight weeks, and two further patients could reduce their treatment to six weeks. The remaining 11 patients were ordered to adhere to the 12-week treatment course.

    The researchers said that one patient relapsed by the end of the study, but noted that the individual had a particularly difficult-to-treat strain of the virus.

    The researchers estimated that the shorter drug-treatment regimen could "save up to 20% of the costs of hepatitis C drugs" and allow patients with more limited health insurance to seek adequate treatment, according to Harel Dahari, a co-author of the study and researcher at Loyola Medicine.

    Real-world implications

    John Bulger, chief medical officer for Geisinger, said the health system's implementation of the new treatment with patients was "fundamentally different" because it was based on evidence of medical efficacy. "There's a certain amount of autonomy and a certain amount of ownership and shared purpose that you create when you do it the way we've done it as opposed to a top-down approach," Bulger said.

    According to Livingston, the payer-provider partnership allowed Geisinger to deliver their evidence-based, hepatitis C treatment regimen to patients quickly—even though a report by the Institute of Medicine revealed it often takes 17 years or more for most medical breakthroughs to reach the exam room.

    "As much as we hail the amazing discoveries here and around the globe, it's taking that long to actually help treat and cure patients," said Ceci Connolly, president and CEO of the Alliance of Community Health Plans. She added that it's important to get "the evidence-based care, the data, the information, the education, the strategies, in the hands of physicians and getting them to act on that information much more rapidly" (Livingston, Modern Healthcare, 11/14; Commins, HealthLeaders Media, 11/14).

    Learn 5 ways to control the flow of drug expenditures

    Prescription drug expenditures are the fastest growing component of health care spending, putting pressure on health systems' inpatient margins while also creating new revenue opportunities in the outpatient setting. And while reducing unwarranted prescribing variation is the single biggest improvement opportunity, there are several other near-term chances to reduce spending and grow revenues.

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